Crash Course in Hospital Disaster Planning and Response for Nurses

A spate of disasters this past decade, including Hurricane Katrina and the Boston Marathon bombing, have shown us as a nation just how vulnerable our health care facilities can be. We’re not as naïve as we were in the pre-September 11th days—and we are learning from each and every disaster. Make sure your hospital, clinic, or other care facility is prepared in case of an emergency so that you can protect patients, staff, and the physical building itself.

The majority of a hospital’s staff is nurses, so hospital disaster planning necessarily involves nurses. Minority populations tend to be hardest hit by disasters—we saw that with Katrina. They were the ones less likely to be able to evacuate. Hospitals must plan for people who speak a different language or persons with different cultural backgrounds and religious beliefs. Follow these steps so you’ll be prepared for expected emergencies (e.g., power outages), the horribly unexpected (e.g., bioterrorist attacks), and everything in between. Best of all, in planning for disasters at your clinical workplace, you also take steps to safeguard yourself, your family, and your wider community.

Step 1: Your hospital has devised an emergency operations/management plan. Learn it. In order to meet hospital certification/accreditation requirements and myriad federal, state, and local regulations, management has to have emergency plans and procedures on file. In addition, they must keep evacuation equipment on hand and enough generators, portable ventilators, and food and water to last for three days without access to outside resources.

For example, natural disasters (severe weather patterns, such as a storm system) and human-made disasters (such as an accidental or deliberate airplane crash) may be deemed top risks by a certain health care facility. But that organization also has to be prepared for common and ordinary events, such as a building fire, which is the number one reason for a hospital evacuation.

Nurses need to learn all they can about their hospital’s response plan, advises Jacquelyn Nally, RN, BSN, an emergency preparedness HAZMAT program coordinator at Massachusetts General Hospital and an emergency department staff nurse at Newton Wellesley Hospital.

Most hospitals put their emergency plan on an Intranet for staff members, but you can also get more details at a new employee orientation or at a regular staff meeting. “Nurses should ask many questions about the plan, such as: ‘Who will be in charge during an incident?,’ ‘What’s my role if we have an evacuation?,’ ‘What’s my role if there’s a mass casualty?,’ ‘What equipment will be used in these various scenarios?,’ [and] ‘What other resources might be available to me then?,’” explains Nally.

Examples of logistical matters that nurses need to be aware of—and which aren’t usually covered in school—are how to protect patients during a disaster. Your hospital plan may have a designated safe location for tornado or other severe weather conditions on the lowest floor in a windowless interior space. Nurses should also know how to operate equipment in case the power goes out. (For instance, certain outlets are connected to the hospital’s emergency power supply.) Of course, you’ll need to avoid elevators during a power outage or in the event of a fire.

Once familiar with the hospital’s existing plan and procedures, you have an opportunity to influence it by participating on a hospital planning committee. Nurses are a critical part of a hospital’s emergency response team so their involvement in the process is vital.

Step 2: Pump up your knowledge and skills for handling hazards. The key for nurses in all settings and departments is to continue learning more and to take every opportunity to practice your disaster response. The Department of Homeland Security (www.dhs.gov) offers free online courses for clinicians. The Institute of Medicine (http://iom.edu) also has a helpful toolkit for hospital disaster planning.

As part of your continuing education, you can go to FEMA’s website (www.fema.gov) and take the Introduction to the Incident Command System for Healthcare/Hospitals online course (IS-100.HC). It will help you understand how your hospital uses the incident command system. Most large hospitals have coalitions of local (hospital), state, and federal agencies.

“Request unit-based training from your educator or clinical specialist or nurse manager,” says Nally. “The Joint Commission [on Accreditation of Healthcare Organizations] requires hospitals to have drills, so participate when you’re able to in drills and other exercises, like tabletop discussions with fire, police, and health care workers. Volunteer to act as a victim or clinical participant in a training exercise. Your goal is to protect your patients, yourself, other staff members, or the facility.”

One thing that may change during an emergency is the chain of command. “Know who to take direction from. Don’t just go off and do your own thing. Take direction from your nurse manager or the unit leader in charge,” says Nally. “That individual gets direction and information pushed down to the unit, and they feed information and needs back up that chain of command. So there aren’t 10 nurses from one unit calling the president of the hospital.”

Repeated drills and exercises allow nurses to perform their jobs during a disaster without missing a step. You may want to get more training and experience (while helping victims of disasters around the world) by signing up for the Nurse Volunteer Corps and volunteering through the Medical Reserve Corps Network.

Step 3: Make sure your personal and family disaster plan is in place. “When Hurricane Katrina hit, I was called in the middle of the night and had to be ready to go—but I had a nine- and an eleven-year-old at home,” remembers Mary Massey, BSN, MA, PHN, hospital preparedness coordinator at the California Hospital Association’s Hospital Preparedness Program. “My family is my life, so I wasn’t leaving until my family was taken care of.”

Thankfully, Massey had already arranged for childcare and household back-up so she could deploy to Biloxi, Mississippi, quickly. “At home, I always have my ‘go bag’ packed with two weeks of stuff, including food that I regularly replace as it expires,” she explains.

Nurses will have different plans depending on their dependents, which may go beyond family and pets, “to the lady down the street who you get medicine for,” she adds.

The American Red Cross has incredible programs for individuals and families that nurses can access (www.redcross.org/prepare). “You can register ahead of time so that your family or other loved ones (and only those people) can call them to see if you’re okay during a disaster,” says Massey. “The Centers for Disease Control and Prevention’s website [emergency.cdc.gov] also has resources for clinicians, and the general public and even one for kids.” The Ready.gov website, by the US Department of Homeland Security, is another good resource.

Step 4: Acknowledge that we’ve come a long way as a nation in our response to hazards and incidents. Probably the toughest decision hospital management has to make is when to evacuate. “Hospitals must treat patients, protect staff and visitors, and they can’t evacuate in an emergency like a school can,” says Cheri Hummel, vice president of disaster preparedness at the California Hospital Association.

Possibly no city knows that better than New Orleans, which suffered the devastation of Hurricane Katrina, necessitating the evacuation of hospitals in addition to the area’s populace.

“We’ve made plans for evacuating the coast of Louisiana,” says Andress. “To exercise those plans, we enact simulated patient evacuation—putting mannequins in planes, then tracking them, and triaging those ‘patients,’ moving them from hospitals in New Orleans and at-risk locations to safer areas.”

All that planning and drilling paid off in 2008 when Hurricanes Gustav and Ike hit the Louisiana Gulf, only three weeks apart. “They came at us just like Hurricanes Katrina and Rita did three years before, but our response was as different as night and day,” says Andress. “In Katrina, 13 hospitals evacuated pre-storm landfall and 26 evacuated post-storm. During Gustav, a full 63 hospitals evacuated pre-storm landfall and only 10 evacuated post-storm.”

With each and every disaster, we become better prepared to evacuate patients safely. In 2012, when Superstorm Sandy hit the coast of New York and New Jersey, medical personnel performed heroically as hospitals activated their emergency preparedness plans. “We commend NYU Langone,” says Hummel about the medical center’s successful evacuation of some 300 patients from its 700-bed facility. “They didn’t lose any patients or have any significant injuries. They were able to get critical patients distributed to other hospitals. We’ve made leaps and bounds over the past few years. It’s been thrilling in my position to see that, but we can’t say we’re there yet—we don’t know where there is.”

Jebra Turner is a freelance health and business writer based in Portland, Oregon. She frequently contributes to the Minority Nurse magazine and website. Visit her online at www.jebra.com.